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In 13 weeks, I’m headed back to full-time work for the first time since starting a family five years ago. My heart-wrenching challenge over the next three months: How do I find someone to replace, well, me? For 40-plus hours a week, I’ll need someone to watch my two lovely, if exasperating, girls: a 21-month-old who loves Elmo and has taken to cliff-diving off our kitchen counters, and an imaginative kindergartner who sings show tunes on the school bus.

With the clock ticking, my husband and I (or, more truthfully, I alone, since even in 2010, child-care logistics still fall squarely into mom’s lap) begin asking around, assessing the various options in our South Shore town – corporate, nonprofit, or family day care? Nanny or nanny-share? Au pair? Grandma?

And like many who have trod this well-worn path, what I discover is that for middle-class, two-income families, the costs of child care are shockingly high, even though for the people we hire to care for our kids, the pay is shockingly low. And – since no parent or provider wants to sacrifice quality, political support for universal child care is close to nil, and my new employer, like most, doesn’t provide an on-site center or subsidize one off-site – there’s no easy solution.

Soon after deciding to go back to work, I take my 5-year-old to see her first Broadway show in New York City, Mary Poppins. Big mistake.

I come home entranced with the idea of hiring a full-time nanny – flying umbrella optional – and initially this looks promising: According to Care.com, a Waltham-based company that connects caregivers with families for a fee, Massachusetts is the No. 1 state and Boston the No. 1 metro area in a national study of child-care excellence comparing overall quality, availability, and affordability – despite lousy results in that last category. The study determined quality by weighing in caregivers’ years of experience and extras like first-aid certification and CPR training.

The problem with going the nanny route in Massachusetts is cost. According to the site, the average sitter in suburban Boston gets paid $12.15 an hour – or $25,272 a year of 40-hour weeks, which doesn’t factor in a working parent’s commute time. Hello, sticker shock. And that’s just the average. One mom friend who has returned to a full-time job in finance confides she’s paying her nanny an annual salary of, oh, roughly the price of a 2010 Mercedes SUV.

The quality of day care in Massachusetts is quite good, too – if you’re willing and able to pay for it. Thanks to the Department of Early Education and Care, which regulates both home day cares and centers, the state has some of the most stringent rules in the nation.

Recall last year’s brouhaha over the new toothbrushing mandate? That’s just the tip of the sippy cup. The state also requires low caregiver-child ratios (1 adult per 3 infants or per 4 toddlers), well-maintained facilities, and even some early-education course work for providers.

Another sign of quality is that Massachusetts tops the nation with around 900 accredited centers – 29 percent in the state compared with 9 percent nationwide – meaning those facilities have paid to be evaluated by an independent group such as the National Association for the Education of Young Children. (Accreditation isn’t just for bragging rights; some state grants are open to accredited centers only.)

But costs are high here, too. According to the National Association of Child Care Resource & Referral Agencies, a network of more than 700 child-care resource centers, Massachusetts has the highest average day-care costs in the nation: The price tag to place one infant in day care for a year averages $18,773, or 18 percent of the average two-parent family’s wages and a whopping 67 percent of the average single mom’s pay. (A 4-year-old’s care costs $13,158, also a national high.) At the top of the scale, parents around Boston can shell out as much as $2,500 a month on one infant’s care – more than a month’s worth of food, sometimes even more than rent or a mortgage payment. Over 12 months, they’ll spend more than the cost of a school year at a state college.

“We can’t believe the Boston prices,” says Needham mom Heather Chamberlain, 35, a fund-raiser at Boston College, who says she thought the $1,500 a month she paid for infant care in Maryland six years ago was expensive. Now she’s pregnant again and looking at what’s available here. “I want what is best for my children, without a doubt, but the costs seem so crazy that I almost feel forced into the cheapest option.”

And then there’s the guilt. Morra Aarons-Mele, 34, owner of Women Online, a digital marketing firm, tries not to mind when her toddler says his nanny’s name before hers. (Aarons-Mele just had a second baby, by the way, and they’re trying to figure out a raise for nanny Joanna Szukala.)

What really wrenches her gut, though, is an admittedly self-imposed feeling that the high cost is her burden – she preferred a nanny to provide stability for the kids and flexibility for herself and her husband, since they both have demanding jobs that require frequent travel away from the Medford home. “Every time we look at how much child care costs, I feel guilty about it,” says Aarons-Mele, “even though it’s investing in the future for me to work.”

So why the staggering expense? The state’s high cost of living plays a part, as do those low ratios and accreditations. Some say the high prices are a good thing. “Massachusetts is doing it right,” declares Linda Smith, executive director of the National Association of Child Care Resource & Referral Agencies. “This is what it” – excellent care – “really costs.” After all, what would you do without? Do you want your infant sucking on a cheap toy covered in lead paint while one caretaker juggles three other babies? Do you want your child tumbling off a set of swings onto a concrete surface? Do you want a head teacher with no more than a GED and a pulse?

“We are absolutely the most regulated field in Massachusetts, and given what our product is – children – we should be,” says William Eddy, executive director of the Massachusetts Association of Early Education and Care, a trade group representing 600 child-care programs. “While they can be a burden, we accept regulations, we embrace them. But does it add to cost? Of course it does.”

There are some ways for families to trim those costs – paying part of the bill with pretax dollars through a flexible spending account or taking the dependent-care tax credit on their tax return, depending on income. Centers don’t widely advertise it, but some even offer scholarship money.

The reality is, most of us don’t pay $25,000 to $30,000 a year for nannies or center care, because we can’t. Many parents turn to in-home day care, which is as regulated as – but can be cheaper than – center care, since overhead, including rent and labor, is lower. Leah Klein, 36, who works from home as a social media consultant, sent her two kids, now 4 and 6, twice a week to a “fabulous” family day care in her Cambridge neighborhood that cost $70 per child for a full 8-to-5 day, or just slightly more than $18,000 per year – a middle-of-the-road price in a pricey part of the state, and for above-average care, she says. “My children would have plenty of time to be in a larger institution once they reached school age,” she says. “It was a great bridge from family day care to school and worked really well for our schedules and our budget.”

And there is state help for low-income families. Around 55,000 Massachusetts children are in care paid for through financial assistance. For example, three-member families earning $41,000 or less (half the median income for families that size) would qualify. Another 22,000 kids are on the waiting list. However, the quality of preschool classrooms in Boston child-care centers serving these children is often inferior to those serving middle-income families, according to a report released last month by the education-quality nonprofit Boston EQUIP. That’s because the state reimburses centers at below-market rates, so the centers have to try to get by on less. According to a study this September by the National Women’s Law Center, caring for an infant costs a Massachusetts center $2,032 per month. But the state only pays child-care providers $1,181 a month – and they can’t make up the difference by charging parents. Among the corners that get cut are “wages, materials, safety,” says Helen Blank, the Law Center’s director of leadership and public policy. The system is “not giving low-income parents the ability to buy high-quality care.”

Putting aside, for a moment, the high prices, I decide to check out some area centers. According to Boston EQUIP’s Ophelia Navarro, seven Boston centers have gone out of business since state budget cuts in 2008, and infant and toddler programs are especially scarce. When I call the two day-care centers in my South Shore town, both have the same response: “We’re full. Try back next year.” One didn’t even offer a waiting list.

I am beginning to suspect that the high cost of care is driving more decisions not to return to work than any “opt-out revolution” or newly fashionable desire to be home. The reality is, there are plenty of families who need that second paycheck, despite its depletion by child care, and there are also masses of stay-at-home moms who would love to return to work but have taken a look at the economics and conceded defeat.

“I am no longer teaching because a ridiculous amount of my paycheck would have gone to quality child care,” explains Michelle Hebden of Cambridge, 31, a former special-ed teacher staying at home with her 1-year-old daughter. “I heard there are cheaper options for child care, but they are all ‘sketchy.’ Your child may be watching TV all day or may get yelled at harshly or may be allowed to scream in a Pack ’n Play for an hour,” she says. “I dropped in on one during my pregnancy, and I knew there was no way I could ever leave my daughter in such an environment. All the kids were misbehaving. It seemed apparent they were used to getting yelled at or ignored.”

Instead, she plans to stay home until her last child – she wants three or four – goes to school, getting by on her husband’s postdoc salary from MIT. “At some point, his salary will increase, so there is a light at the end of the tunnel,” she says. “I know there isn’t for so many, and for that I’m thankful.”

Aarons-Mele, the Medford entrepreneur with the nanny, also occasionally wonders if it would be easier to stay home, raise her children, and support her husband’s career. “There wouldn’t be this constant sense of both sides trying to compromise,” she says. “We’re all caught in this huge gender role shift. Men know they’re supposed to act supportive, but I’m not sure they want to be supportive” of women’s new roles. “Women know they’re supposed to work, and they’re not sure they always want to.”

Then there’s the new, science-supported guilt. Over and over, the early-education experts I talk to drum into my head the importance of the first five years of a child’s life. Their intention is to argue for public funding for high-quality early education. Instead, they’re giving me a complex for wanting to work at something other than mothering and daring to entrust my children’s development to anyone else.

In the hopes of keeping costs down but still providing one-on-one attention to my younger child (and two-on-one after school), I decide to seek out a creative alternative: the au pair system, which allows a foreign exchange student to provide 45 hours of child care a week in return for room and board, a weekly stipend of just under $200, and the “cultural” experience of camping out in an American basement in the burbs.

Despite my initial apprehension, I am ready to welcome a caregiver from Cambridge’s Cultural Care Au Pair agency into my home. Then, just as we’re about to start furnishing the spare room, she flakes in favor of the far-easier gig of shuttling a 12-year-old Duxbury girl to her after-school activities.

I am crushed, then get cold feet on the concept. Sharing our home, car, and responsibilities with a tattooed 21-year-old? A Swedish blonde, to boot? What was I thinking? Eleven weeks to go.

When I talk to Lisa St. Hill, who works in the child-care industry, it stops me in my selfish, entitled, bourgeoisie tracks. Because while working parents like to moan and groan about paying for care, even knowing implicitly it’s a middle- and upper-class problem, workers in the industry have it much, much tougher.

St. Hill, 41, is a single mom living in Charlestown who makes around $450 a week before taxes working at Ellis Memorial’s infant room in the South End. (There is a 180-family, year-plus-long waiting list, by the way, for the nonprofit’s 14 infant and 27 toddler spaces.) Her daughter, Lizelle, 11, attends public school in Dorchester and goes to after-school care while St. Hill works 35 hours per week and receives health benefits.

Two nights a week, St. Hill takes classes in early education at Urban College of Boston, paying her own baby sitter $10 an hour to watch her daughter. “It’s tough,” she understates.

It’s also typical. The average Massachusetts child-care worker makes $24,480 a year, or about 12 bucks an hour, according to 2009 US Labor Department data. That means many are on food stamps or public assistance themselves. That means turnover rates are second only to fast-food workers. “Our early-ed teachers are the working poor,” says Mary Reed, president and CEO of the Bessie Tartt Wilson Initiative for Children, a Boston-based nonprofit research and advocacy group focused on early education.

Maria Teixeira, St. Hill’s boss at Ellis Memorial and the program director for early education there, defines the problem in a nutshell: “People don’t see early education as a profession, they see it as baby-sitting.” And it’s true. We parents want the moon: caring, patient, loving, well-educated caregivers – just don’t ask us to provide health care or sick leave, and don’t charge us more than 10 bucks an hour.

“The average salary went from $17,000 to $23,000 in a decade, so it’s a system that needs overhaul,” says Eddy, of the Massachusetts Association of Early Education and Care. “You’re seeing a number of teachers getting degrees, but, to date, salaries haven’t followed.”

Teixeira herself started out like St. Hill, entering the field after high school, then beginning to work toward her associate’s degree. She tapped into the $3 million pool of state scholarship money available to early-childhood educators and went back for her bachelor’s degree, which took two years of nights and weekends to earn. After getting her master’s this May, she has a $20,000 loan to pay back. (Director salaries at Ellis Memorial, she says, range from $45,000 to $50,000.) “It’s still very depressing,” she sighs. “You’re not going to get rich being a day-care provider.”

For Ellis Memorial’s center to keep accreditation, half of its teachers must have associate’s degrees by the end of this year, and bachelor’s by 2015. Teixeira says some good teachers are fleeing the system, daunted by the prospect of returning to school, but many have earned their degrees – and now want something in return. “They’re saying, ‘Show me the money.’ I tell them to hang in there.” But when they don’t get that pay bump, many who are better educated will defect to become teachers in the public school system, where the starting salary is significantly higher.

With nine weeks to go, we finally catch a break. Our longstanding nights-and-weekends baby sitter may be interested in our daytime job. Why do I feel like I’ve won the lottery?

There must be a villain in this story, somewhere. If families are strapped and workers are paid a pittance, then the day-care center operators must be making out like bandits, right? Not necessarily. “I think of early childhood as a break-even business,” says Jeanne Lovy, assistant vice president and director of early learning for the Jewish Community Centers of Greater Boston, which operates six nonprofit child-care facilities (including one my toddler attends twice a week).

Even a chain with centers around North America and the UK, like Watertown-based Bright Horizons Family Solutions, which has economies of scale and corporate clients, showed only modest profits in its last financial statements made as a public company (it was taken private by Bain Capital in 2008, but a company representative confirms that current profits aren’t impressive, either). Much of the company’s revenue, up to 80 percent, goes right out the door to teachers’ wages and benefits. Insurance, rent, maintenance, taxes, heating and cooling bills, cleaning supplies, snacks, and – yes – buying toothbrushes takes care of the rest.

“We call this the ‘trilemma’ – the triangle between quality, cost for parents, and wages,” Lovy says. “Everything is interrelated. If you change one corner, you affect everything else.” In other words, raise your staff’s salaries, and you’ll make it less affordable for parents. Make it more affordable, and you’ll have to cut corners. “The good news is, if you’re a parent in Massachusetts, you have some great choices,” Lovy says. The bad news: “Everybody is maxed in the system. Parents pay as much as they can, teachers earn the lowest wage you can live on, and we all want the highest quality possible. It’s very tough.”

There seems to be a tacit recognition that parents can’t pay any more, and workers can’t be paid less. Yet the quest to improve quality marches on. In report after report, advocacy groups lay out lofty visions. Thrive in Five Boston proposes that, by early in the next decade, all centers should be accredited and all early educators have a college degree in a related field. The Bessie Tartt Wilson Initiative wants a state-funded 15 percent tax credit for early educators, loan forgiveness for those who stay in the field, better compensation, and a private endowment to help fund wages. Strategies for Children suggests helping workers with tuition and career development. And the National Women’s Law Center hopes for federal and state funding to increase the numbers of high-quality infant and toddler programs, boost reimbursement rates to centers and home-care providers, and strengthen the dependent-care tax credit. The money would have to come from somewhere. “Parents cannot support a quality system based on private fees alone,” says Joanne Gravell of Child Care Connection, a program of Family Services of Central Massachusetts, a nonprofit in Worcester.

That’s going to be a tough sell. State funding for early education and care services has already been cut around 16 percent since 2009, according to the Massachusetts Budget and Policy Center. And if the country can’t even muster the political momentum to establish paid maternity leave, the kind offered by, say, pretty much every other Western nation, do you really think it will get behind the Holy Grail of federally subsidized child care for all? “There’s been a growing recognition of the early years to children’s development and success, but the recognition hasn’t been matched with action,” says Blank. “You would think this would be a no-brainer. But it’s been 20 years since we enacted federal child-care assistance, and we still serve 1 in 6 children.”

Start talking public funding, and you get a strong reaction among those who insist the responsibility is not theirs. Witness the vitriol triggered by a 2009 Boston Herald article addressing cutbacks in the state’s day-care subsidies for low-income families: “It’s madness that I have to pay higher and higher taxes and work longer hours to pay for someone else’s freakin’ day care bill,” wrote one online commenter. And, most bluntly, “If you cant feed ’em, don’t breed ’em.”

But Smith, of the National Association of Child Care Resource & Referral Agencies, argues that ultimately the public does not buy that response. “In America, should two people working every day making minimum wage not be able to have a child?” she asks. “To me, there is something wrong with us as a country if we’re saying only upper-income people can afford to have kids.” She continues: “We look at K-12 education as free, higher education as partially a public responsibility, but child care we see as up to the parents only. Is there a public responsibility here – and what is it?”

As for my family, we end up doing pretty much what the data predicted we would: We cobble together a plan. Even if there were space, my husband can’t stomach putting our younger daughter in full-time center care, no matter how high the quality. And the family care available in our town doesn’t cover enough hours.

So we suck up the cost, as other families do. We keep our younger daughter in her program two mornings a week, wheedle an afternoon of freebie care from Grandma, and pay out the nose for a top-notch sitter for the remaining hours. Pray for us, come flu season.

Melissa Schorr recently began a yearlong stint as an assistant editor at the Globe Magazine. E-mail her at mschorr@globe.com.